Dose to swallowing structures and dysphagia in head and neck Intensity Modulated Radiation Therapy – A long term prospective analysis

AimTo analyse the long term swallowing function in head and neck cancer patients and correlate with the dose to midline swallowing structures.BackgroundThe use of concurrent chemo radiation (CRT) as the present standard of care resulted in high rates of early and late toxicities. Dysphagia, aspiration, and xerostomia are early as well as late effects of radiation. Not many studies on the dysphagia scores during radiation and follow-up period have correlated dose to the swallowing structures, hence this study.Materials and MethodsHistologically proven head and neck cancer patients treated with intensity modulated radiation therapy were accrued in this study. The pharyngeal constrictors, larynx and cervical oesophagus were contoured and labelled as midline swallowing structures. The volume of the midline swallowing structures which were outside the PTV was delineated separately and was given a mean dose constraint of 45 Gy. Dysphagia was assessed at baseline, weekly intervals during irradiation and follow-up at six years. The dose to the structures for swallowing was correlated with degree of dysphagia.ResultsThere was a gradual increase in the dysphagia grade during the course of radiation. There was a significant recovery of late dysphagia compared to dysphagia during the completion of radiation therapy in patients who received <45 Gy to the swallowing structures (p < 0.0001).ConclusionGiving a constraint to the swallowing structure and limiting it to <45 Gy resulted in earlier recovery of swallowing function resulted in good physical, mental and social well being of the patients when compared to those who received >45 Gy.     

Feasibility of Tomotherapy-Based Image-Guided Radiotherapy to Reduce Aspiration Risk in Patients with Non-Laryngeal and Non-Pharyngeal Head and Neck Cancer

Purpose

The study aims to assess the feasibility of Tomotherapy-based image-guided radiotherapy (IGRT) to reduce the aspiration risk in patients with non-laryngeal and non-hypopharyngeal cancer. A retrospective review of 48 patients undergoing radiation for non-laryngeal and non-hypopharyngeal head and neck cancers was conducted. All patients had a modified barium swallow (MBS) prior to treatment, which was repeated one month following radiotherapy. Mean middle and inferior pharyngeal dose was recorded and correlated with the MBS results to determine aspiration risk.

Results

Mean pharyngeal dose was 23.2 Gy for the whole group. Two patients (4.2%) developed trace aspiration following radiotherapy which resolved with swallowing therapy. At a median follow-up of 19 months (1–48 months), all patients were able to resume normal oral feeding without aspiration.

Conclusion and Clinical Relevance

IGRT may reduce the aspiration risk by decreasing the mean pharyngeal dose in the presence of large cervical lymph nodes. Further prospective studies with IGRT should be performed in patients with non-laryngeal and non-hypopharyngeal head and neck cancers to verify this hypothesis.     

穴位按摩联合高压氧对急性脑卒中后吞咽功能障碍临床效果

目的:研究穴位按摩联合高压氧对急性脑卒中后吞咽功能障碍的临床效果。方法:选择2016年1月～2018年12月我院收治的80例急性脑卒中后吞咽功能障碍患者,将其随机分为两组。对照组采取高压氧治疗,观察组采取穴位按摩联合高压氧治疗。观察和比较两组吞咽功能障碍的改善效果。结果:观察组的吞咽功能障碍改善有效率明显高于对照组(P0.05);两组治疗15 d和30 d的洼田饮水试验评分均明显低于治疗前1 d(P0.05),且观察组明显低于对照组(P0.05);两组治疗后的吞咽障碍特异性生活质量量表(Swallowing quality-of-life questionnaire,SWAL-QOL)评分均明显低于治疗前(P0.05),且观察组明显低于对照组(P0.05);观察组吸入性肺炎的发生率为7.50%(3/40),明显低于对照组[25.00%(10/40)](P0.05)。结论:穴位按摩联合高压氧可促进急性脑卒中后吞咽功能障碍患者吞咽功能的恢复,防止吸入性肺炎的发生,提高患者生活质量。     

Stem cell treatments for oropharyngeal dysphagia: Rationale,benefits, and challenges

Dysphagia, defined as difficulty swallowing, is a common symptom negatively impacting millions of adults annually. Estimated prevalence ranges from 14 to 33 percent in those over age 65 to over 70 percent in a nursing home setting. The elderly, those with neurodegenerative diseases, head and neck cancer patients, and those with autoimmune conditions such as Sjögren's syndrome are disproportionately affected. Oropharyngeal dysphagia refers specifically to difficulty in initiating a swallow due to dysfunction at or above the upper esophageal sphincter, and represents a large proportion of dysphagia cases. Current treatments are limited and are often ineffective. Stem cell therapy is a new and novel advancement that may fill a much-needed role in our treatment regimen. Here, we review the current literature regarding stem cell treatments for oropharyngeal dysphagia. Topics discussed include tissue regeneration advancements as a whole and translation of these principles into research surrounding tongue dysfunction, xerostomia, cricopharyngeal dysfunction, and finally an overview of the challenges and future directions for investigation. Although this field of study remains in its early stages, initial promising results show potential for the use of stem cell-based therapies to treat oropharyngeal dysphagia and warrant further research.     

于氏头针结合颈项部针刺法治疗脑出血恢复期吞咽障碍*

目的:观察于氏头针结合颈项部针刺法治疗脑出血恢复期吞咽障碍的有效性和安全性。方法:选取150例脑出血恢复期吞咽困难的患者,随机分为于氏项针、头针+颈项部针刺+偏瘫侧肢体针刺(治疗组)75例和除项区外的于氏头针+颈项部针刺+偏瘫侧肢体针刺(对照组)75例。采用洼田氏饮水试验、肺炎发生率、拔除胃管时间及EAT-10量表测评。根据以上量表及评分,给出相应结论。结果:洼田饮水量表显示,两组患者治疗前后均有好转,治疗组平均恢复等级小于对照组。对比拔除胃管平均时间,两组相差6.347天,可见疗效显著。且肺炎发生率两组相差20.6%。同时EAT-10量表也显示治疗组分数每周均小于对照组,可见起效快,效果稳定。结论:于氏头针结合颈项部针刺法治疗脑出血恢复期吞咽障碍疗效确切,可以提高患者的生活质量,值得临床推广。     

Is pulse oximetry a reliable tool for detection of aspiration?

This study was designed to determine whether significant differences in saturation levels existed among patients with aspiration and patients without and wether pulse oximetry can reliably detect aspiration in patients with dysphagia. We also examined the effects of gender and disease (neurologic versus non neurologic) on saturation levels. We studied 38 patients. They all underwent a videofluoroscopic study of swallowing (VFSS). Twenty patients aspirated on videofluoroscopic study of swallowing: ten patients were solid aspirators, ten patients were liquid aspirators. In each group (liquid aspirators, solid aspirators or non aspirators) we found no significant difference in saturation levels. We found however a significant difference in saturation levels between each group before, during and after videofluoroscopic study of swallowing. Both gender and disease had an effect on saturation levels. We conclude that pulse oximetry can not serve as a screening tool for detection of aspiration as saturation levels are dependent on many factors. Therefore one can not reliably predict aspiration with a single saturation screening.     

神经肌肉电刺激联合吞咽康复训练对脑卒中后吞咽障碍患者吞咽功能、表面肌电图及舌骨喉复合体动度的影响

摘要 目的：观察吞咽康复训练、神经肌肉电刺激（NMES）联合治疗对脑卒中后吞咽障碍患者吞咽功能、表面肌电图及舌骨喉复合体动度的影响。方法：选取2018 年9月~2020年10 月期间在我院治疗的70例脑卒中后吞咽障碍患者,根据住院号尾数的奇偶将患者分为对照组和实验组,各35例。对照组仅进行吞咽康复训练,实验组在此基础上接受NMES治疗,两组均治疗2个疗程,观察治疗前后两组患者吞咽功能、表面肌电图、舌骨喉复合体动度及生活质量变化。结果：治疗2个疗程后,实验组患者的吞咽功能改善总有效率高于对照组,组间比较有显著性差异（P<0.05）。治疗2个疗程后,两组吞咽时程缩短、最大波幅值升高,且实验组的吞咽时程短于对照组,最大波幅值高于对照组（P<0.05）。治疗2个疗程后,两组舌骨上移距离、舌骨前移距离、甲状软骨上移距离、甲状软骨前移距离增大,且实验组的舌骨上移距离、舌骨前移距离、甲状软骨上移距离、甲状软骨前移距离大于对照组（P<0.05）。治疗2个疗程后,两组SWAL-QOL总分均升高,且实验组的SWAL-QOL总分高于对照组（P<0.05）。结论：NMES联合吞咽康复训练应用于脑卒中后吞咽障碍患者,可有效促进其吞咽功能改善,提高舌骨肌肌群肌力及生活质量。     

头颈部恶性肿瘤患者放疗后吞咽困难的危险因素分析及吞咽功能训练的临床应用价值

摘要 目的：分析头颈部恶性肿瘤（HNC）患者放疗后吞咽困难的危险因素,并观察吞咽功能训练的临床应用效果。方法：选择2020年4月~2022年5月期间在华中科技大学同济医学院附属同济医院接受放疗的HNC患者150例。采用自制调查量表获取患者的一般资料,采用单因素和多因素Logistic分析HNC患者放疗后吞咽困难的危险因素,并观察吞咽功能训练的临床应用效果。结果：本研究中150例HNC患者,放疗后出现吞咽困难的有93例,吞咽困难发生率为62.00%。根据放疗后是否出现吞咽困难将患者分为无吞咽困难组（n=57）和吞咽困难组（n=93）。单因素分析显示,HNC患者放疗后吞咽困难与文化程度、婚姻状况、高血压、糖尿病、高脂血症、居住地、体质量指数无关（P>0.05）,而与年龄、性别、吸烟史、饮酒史、肿瘤分期、肿瘤位置、累积放疗剂量有关（P<0.05）。多因素Logistic回归分析,结果显示：年龄偏大、男性、吸烟史、饮酒史、肿瘤分期为III期、肿瘤位置为颈部肿瘤、累积放疗剂量偏高是HNC患者放疗后吞咽困难的危险因素（P<0.05）。HNC患者干预1个月后、干预2个月后安德森吞咽困难量表（MDADI）评分较干预前下降,功能性经口摄食量表（FOIS）评分较干预前升高（P<0.05）。结论：HNC患者放疗后吞咽困难的发生率较高,年龄、性别、吸烟史、饮酒史、肿瘤分期、肿瘤位置、累积放疗剂量等均是其影响因素。HNC患者放疗期间给予吞咽功能训练,可有效改善患者的吞咽状况。     

EphA3 maintains radioresistance in head and neck cancers through epithelial mesenchymal transition

Radiotherapy is a well-established therapeutic modality used in the treatment of many cancers. However, radioresistance remains a serious obstacle to successful treatment. Radioresistance can cause local recurrence and distant metastases in some patients after radiation treatment. Thus, many studies have attempted to identify effective radiosensitizers. Eph receptor functions contribute to tumor development, modulating cell-cell adhesion, invasion, neo-angiogenesis, tumor growth and metastasis. However, the role of EphA3 in radioresistance remains unclear. In the current study, we established a stable radioresistant head and neck cancer cell line (AMC HN3R cell line) and found that EphA3 was expressed predominantly in the radioresistant head and neck cancer cell line through DNA microarray, real time PCR and Western blotting. Additionally, we found that EphA3 was overexpressed in recurrent laryngeal cancer specimens after radiation therapy. EphA3 mediated the tumor invasiveness and migration in radioresistant head and neck cancer cell lines and epithelial mesenchymal transition- related protein expression. Inhibition of EphA3 enhanced radiosensitivity in the AMC HN 3R cell line in vitro and in vivo study. In conclusion, our results suggest that EphA3 is overexpressed in radioresistant head and neck cancer and plays a crucial role in the development of radioresistance in head and neck cancers by regulating the epithelial mesenchymal transition pathway.     

Neoadjuvant chemotherapy in head and neck cancer

BACKGROUND: Neoadjuvant chemotherapy has an increasing role in multimodality treatment of advanced head and neck cancer. In this paper we summarize our first results with this treatment. METHOD: Thirty-five, previously untreated, mostly inoperable head and neck cancer patients were given two cycles of Cisplatin and 5FU chemotherapy. We continued the therapy only in case of regression until four cycles, then the patients received surgical and/or radiotherapy according to their status. After the treatment patients' status was regularly evaluated. RESULTS: We detected 4 complete and 20 partial responses after the chemotherapy. Three patients became eligible for a radical operation. At this moment 10 patients are free of tumor, 8 patients died in consequence of the tumor, we have no data in 3 cases, 3 patients are given palliative therapy because of progression, 4 patients are receiving radiotherapy and 7 patients with partial response are candidates for further active oncotherapy. CONCLUSIONS: Although the number of the patients we treated is too small for a statistical analysis, our results are similar to the conclusion of the large randomized studies: after neoadjuvant chemotherapy of advanced head and neck cancer partial response can improve the result of surgical or radiological treatment. Neoadjuvant chemotherapy does not improve survival in advanced head and neck cancer, but it is of great importance because of better quality of life of patients, especially those who had organ preserving therapy.     

功能与分子影像在头颈部肿瘤放射治疗计划和疗效评价中的应用

目前临床普遍采用功能与分子影像检测手段能来评价头颈部肿瘤的放射治疗计划和疗效,可指导个体化治疗从而提高疗效。文章概述了功能与分子影像技术CT,MRI,PET-CT,超声检测技术在头颈部肿瘤放射治疗计划制定和疗效评价中的应用进展。结果显示,不同分子影像检测方法如在检查时机的选择、诊断和鉴别诊断的价值、观察放射治疗后肿瘤的残存和复发、预测放射治疗效果、指导后续治疗等方面均可起到重要作用。采用图像融合技术进行联合应用,如PET-CT和MRI-CT等,可提高检测的准确率。临床医生需在常规影像学手段的基础上,根据头颈部肿瘤患者病情和治疗方法的不同选用正确的功能和分子影像检测手段,更好地指导制定放射治疗计划及综合评价放射治疗后的疗效。     

Role of impaired DNA repair in genotoxic susceptibility of patients with head and neck cancer

DNA repair is critical for genotoxic susceptibility and cancer development. Forty-seven patients with head and neck squamous cell carcinoma (HNSCC) and 38 healthy controls were enrolled in this study. Among the patients, 16 subjects had metastasis of HNSCC. The extent of DNA damage, including oxidative lesions, and efficiency of repair after genotoxic treatment with hydrogen peroxide were examined using the alkaline comet assay. HNSCC cells were sensitive to genotoxic treatment and displayed impaired DNA repair. In particular, lesions caused by hydrogen peroxide were repaired less effectively in cancer cells from patients with metastasis than in cells from healthy controls. We suggest that impaired DNA repair might play a role in genotoxic susceptibility of patients with head and neck cancer. Finally, as a consequence of this finding we have shown that treatment with DNA-reactive drugs could be considered as an effective therapy strategy for head and neck cancer.     

Cetuximab augments cytotoxicity with poly (adp-ribose) polymerase inhibition in head and neck cancer

Overexpression of the epidermal growth factor receptor (EGFR) is a hallmark of head and neck cancers and confers increased resistance and inferior survival rates. Despite targeted agents against EGFR, such as cetuximab (C225), almost half of treated patients fail this therapy, necessitating novel therapeutic strategies. Poly (ADP-Ribose) polymerase (PARP) inhibitors (PARPi) have gained recent attention due to their unique selectivity in killing tumors with defective DNA repair. In this study, we demonstrate that C225 enhances cytotoxicity with the PARPi ABT-888 in UM-SCC1, UM-SCC6, and FaDu head and neck cancer cells. The mechanism of increased susceptibility to C225 and PARPi involves C225-mediated reduction of non-homologous end-joining (NHEJ)- and homologous recombination (HR)-mediated DNA double strand break (DSB) repair, the subsequent persistence of DNA damage, and activation of the intrinsic apoptotic pathway. By generating a DSB repair deficiency, C225 can render head and neck tumor cells susceptible to PARP inhibition. The combination of C225 and the PARPi ABT-888 can thus be an innovative treatment strategy to potentially improve outcomes in head and neck cancer patients. Furthermore, this strategy may also be feasible for other EGFR overexpressing tumors, including lung and brain cancers.     

Cortical swallowing processing in early subacute stroke

Background  

Dysphagia is a major complication in hemispheric as well as brainstem stroke patients causing aspiration pneumonia and increased mortality. Little is known about the recovery from dysphagia after stroke. The aim of the present study was to determine the different patterns of cortical swallowing processing in patients with hemispheric and brainstem stroke with and without dysphagia in the early subacute phase.     

The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing.

Surface electrical stimulation is currently used in therapy for swallowing problems, although little is known about its physiological effects on neck muscles or swallowing. Previously, when one surface electrode placement was used in dysphagic patients at rest, it lowered the hyolaryngeal complex. Here we examined the effects of nine other placements in normal volunteers to determine 1) whether movements induced by surface stimulation using other placements differ, and 2) whether lowering the hyolaryngeal complex by surface electrical stimulation interfered with swallowing in healthy adults. Ten bipolar surface electrode placements overlying the submental and laryngeal regions were tested. Maximum tolerated stimulation levels were applied at rest while participants held their mouths closed. Videofluoroscopic recordings were used to measure hyoid bone and subglottic air column (laryngeal) movements from resting position and while swallowing 5 ml of liquid barium, with and without stimulation. Videofluoroscopic recordings of swallows were rated blind to condition using the National Institutes of Health-Swallowing Safety Scale. Significant (P < 0.0001) laryngeal and hyoid descent occurred with stimulation at rest. During swallowing, significant (P 相似文献   

Effect of Seihai-to, a Kampo medicine, in relapsing aspiration pneumonia an open-label pilot study

Two published case reports described palliation of disease after Seihai-to therapy for refractory aspiration pneumonia caused by recurrent laryngeal nerve paralysis and cerebrovascular disease. We undertook an open-label trial in patients with relapsing aspiration pneumonia. Fifteen patients with relapsing aspiration pneumonia were randomly divided into conventional therapy group (n = 8) or Seihai-to group (n = 7). In Seihai-to group, patients were treated with Seihai-to in addition to conventional therapy (Western medicines). Frequency of feverish days and antibiotics-use, CRP value and chest CT or X-ray findings were compared between the two groups during the study period of 16 weeks. In the Seihai-to group, the latency of swallowing reflex was measured in 6 patients before and after administration of Seihai-to. The mean values of fever index, CRP value and antibiotics-use in the Seihai-to group were decreased significantly, compared with those of the conventional therapy group. However, the latency of the swallowing reflex after 4 weeks of treatment was not significantly changed (p = 0.249), compared with the latency before administration of Seihai-to. No adverse reaction was observed in either group. Seihai-to was effective in reducing relapse of aspiration pneumonia in this small group. Seihai-to might not improve the swallowing reflex, but might instead improve a defense mechanism or excessive inflammation caused by pneumonia in the lower airway. Further evaluation of Seihai-to therapy for patients with aspiration pneumonia in a larger population is warranted.     

Reconstruction of large composite oromandibulomaxillary defects with free vertical rectus abdominis myocutaneous flaps

Large composite oromandibulomaxillary defects resulting from oncologic resection can be challenging to reconstruct with a single flap, and functional outcomes remain anecdotal. The purpose of this study was to evaluate the authors' surgical experience and scientifically analyze and describe the functional outcomes associated with the use of the vertical rectus abdominis myocutaneous flap for reconstruction of these defects. The records of seven patients (mean age, 62 years) who underwent composite resection including hemimandibulectomy, partial maxillectomy, partial pharyngectomy, and floor-of-mouth resection followed by immediate free vertical rectus abdominis myocutaneous flap reconstruction at The University of Texas M. D. Anderson Cancer Center (1998 to 2002) were retrospectively reviewed. The tumor type was squamous cell carcinoma in all seven cases; four patients had T4 primary lesions and three had local recurrences. Radiotherapy was used preoperatively in each of the three recurrent cases (mean dose, 70.6 Gy) and postoperatively in three of the four patients with primary tumors (mean dose, 63.0 Gy). The mean length of hospitalization was 8.7 days. There were no major flap complications, fistulas, or donor-site complications. Partial flap necrosis (4 percent of flap area) occurred in one patient and dehiscence of the neck incision occurred in another. Both cases were managed with surgical débridement and closure. A third patient developed a 0.75-cm superficial suture line abscess that healed with dressing changes. The mean postoperative follow-up was 15 months. Six of the seven patients remained tube dependent for their nutrition despite some swallowing improvement; one patient returned to full oral intake. The most common swallowing deficit was impaired laryngeal excursion, which occurred in all six patients evaluated with videofluoroscopic examination and resulted in risk for aspiration in patients and frank aspiration in 83 percent. Speech was intelligible on routine follow-up visits in all patients except one. Four patients died as a result of their cancer, one was alive with metastatic disease, and two were alive with no evidence of disease at last follow-up. The goal for patients undergoing extensive composite oromandibulomaxillary resection for advanced cancer is to restore structure, minimize postoperative morbidity, and optimize the quality of remaining life. Reconstruction with the free vertical rectus abdominis myocutaneous flap achieves early wound healing, allows timely delivery of adjuvant therapy, and can be accomplished with predictable success and minimal morbidity. To our knowledge, this study represents the first to scientifically analyze and quantify swallowing function following free vertical rectus abdominis myocutaneous flap reconstruction for large oromandibulomaxillary defects. Understanding of the specific physiologic swallowing deficits that typically occur after such reconstructions will provide clinicians with important surgical and reconstructive information to enable future improvements in functional success in a population for whom the prognosis is poor and treatment options are limited.     

An overview of gene therapy in head and neck cancer

Gene therapy is a new treatment modality in which new gene is introduced or existing gene is manipulated to cause cancer cell death or slow the growth of the tumor. In this review, we have discussed the different treatment approaches for cancer gene therapy; gene addition therapy, immunotherapy, gene therapy using oncolytic viruses, antisense ribonucleic acid (RNA) and RNA interference-based gene therapy. Clinical trials to date in head and neck cancer have shown evidence of gene transduction and expression, mediation of apoptosis and clinical response including pathological complete responses. The objective of this article is to provide an overview of the current available gene therapies for head and neck cancer.     

The effects of the traditional chinese medicine, "Banxia Houpo Tang (Hange-Koboku To)" on the swallowing reflex in Parkinson's disease.

Swallowing disorder is common in Parkinson's disease (PD). We studied the swallowing disorder in PD, and tested the efficacy of Banxia Houpo Tang (BHT, a Chinese traditional medicine) in improving the swallowing reflex of PD patients. The Swallowing reflex test is a simple method used to detect swallowing disorders in patients with cerebrovascular disease. Because we observed previously that BHT significantly improved the swallowing reflex in cerebrovascular patients, we studied whether BHT was also effective in improving the swallowing disorder in patients with PD. 23 PD patients (13 males, 10 females, mean age 66.0+/-9.3, Hoehn & Yahr (H-Y) mean score = 2.8) were evaluated for swallowing reflex and the concentration of substance-P in their saliva before and after 4 weeks of BHT treatment. The swallowing reflex before treatment was significantly delayed, according to the H-Y score (Spearman's p = 0.014, R2 = 0.463). The swallowing reflex before BHT treatment was 3.66+/-0.98 sec, and after BHT treatment, it improved significantly, to 2.27+/-0.54 sec (p < 0.0001). Substance-P concentration in PD patients saliva before treatment was significantly lower than in healthy controls (p = 0.007), but showed no significant change after BHT treatment. Our research shows that the swallowing reflex is an effective method to evaluate the swallowing disorder in PD. BHT can significantly improved the swallowing reflex in PD patients, and therefore can be a hopeful candidate for preventing aspiration pneumonia in PD.     

Evaluation of normal swallowing functions by using dynamic high-density surface electromyography maps

Background

Swallowing is a continuous process with substantive interdependencies among different muscles, and it plays a significant role in our daily life. The aim of this study was to propose a novel technique based on high-density surface electromyography (HD sEMG) for the evaluation of normal swallowing functions.

Methods

A total of 96 electrodes were placed on the front neck to acquire myoelectric signals from 12 healthy subjects while they were performing different swallowing tasks. HD sEMG energy maps were constructed based on the root mean square values to visualize muscular activities during swallowing. The effects of different volumes, viscosities, and head postures on the normal swallowing process were systemically investigated by using the energy maps.

Results

The results showed that the HD sEMG energy maps could provide detailed spatial and temporal properties of the muscle electrical activity, and visualize the muscle contractions that closely related to the swallowing function. The energy maps also showed that the swallowing time and effort was also explicitly affected by the volume and viscosity of the bolus. The concentration of the muscular activities shifted to the opposite side when the subjects turned their head to either side.

Conclusions

The proposed method could provide an alternative method to physiologically evaluate the dynamic characteristics of normal swallowing and had the advantage of providing a full picture of how different muscle activities cooperate in time and location. The findings from this study suggested that the HD sEMG technique might be a useful tool for fast screening and objective assessment of swallowing disorders or dysphagia.